A 53-year-old underwent an abdominal computed tomography for hematuria that incidentally discovered a cystic lesion of the pancreas. Endoscopic ultrasound revealed a structure with debris and septations; fine-needle aspiration with negative cytology but elevated tumor marker suggested a mucinous cystic neoplasm or an intraductal papillary mucinous neoplasm. Laparoscopic excision confirmed a walled-off cyst detachable from the posterior aspect of the pancreas consistent with a ciliated foregut cyst. There are limited data on ciliated foregut cysts of the pancreas, and the current report highlights the diagnostic dilemma and a review of the current literature.